Comparison Between Fusion and Non-Fusion Surgery for Lumbar Spinal Stenosis: A Meta-analysis

Shen, Jian; Wang, Qiang; Yingmin, Wang; Min, Nan; Wang, Lin; Wang, Fei; Zhao, Maoyu; Zhang, Tong‐Yi; Xue, Qingyun

doi:10.1007/s12325-020-01604-7

Cited by 16 publications

(12 citation statements)

References 17 publications

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“…Ahmed et al [17] and Saleh [18] concluded that decompression with fusion had better outcomes than decompression alone, in terms of Oswestry disability index (ODI), VAS, and the Japanese Orthopedic Association score. In contrast to their findings, Shen et al [19] supported that there were no significant differences in clinical outcomes, considering ODI. Aihara et al [20] reported that significantly shorter operation time and hospitalization, and significantly less blood loss were observed in the decompression group.…”

Section: A B Cmentioning

confidence: 73%

Only Surgical Decompression Is Sufficient for Multilevel Lumbar Spinal Stenosis with Calcified Disc Protrusion and Vacuum Disc: Case Reports

Moon

Kang

Lee

et al. 2022

J Minim Invasive Spine Surg Tech

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The purpose of this report was to share our successful cases of only surgical decompression for symptomatic multilevel lumbar spinal stenosis, by assessing treatment outcomes and perioperative complications. Two patients who had only surgical decompression for symptomatic multilevel lumbar spinal stenosis in March and May 2021 were investigated. They were preoperatively diagnosed with the calcified disc protrusion and vacuum disc in the intervertebral space by magnetic resonance imaging (MRI) and computed tomography (CT). The chief complaints were severe low back pain and bilateral sciatica 2 or 3 months ago. The patients reported also reported difficulty walking due to sciatica, for which they were admitted to Daegu Wooridul Spine Hospital. Under general anesthesia unilateral laminotomy for bilateral decompression (ULBD) was performed and discectomy was not done on the stenosis levels. Treatment outcomes were analyzed by preoperative and postoperative visual analog scale (VAS) for low back pain and sciatica (Back VAS and Leg VAS), improvement in walking, and postoperative MRI. Treatment outcomes were favorable: Low back pain and bilateral sciatica showed a VAS score improvement (Back VAS=3, Leg VAS=3), the patient’s walking was improved, and on a postoperative MRI of the two patients, the thecal sac was released sufficiently. The patients developed no perioperative complications. Only surgical decompression is an effective method for symptomatic multilevel lumbar spinal stenosis with calcified disc protrusion and vacuum disc in not the spinal canal but the intervertebral space.

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Section: A B Cmentioning

confidence: 73%

Only Surgical Decompression Is Sufficient for Multilevel Lumbar Spinal Stenosis with Calcified Disc Protrusion and Vacuum Disc: Case Reports

Moon

Kang

Lee

et al. 2022

J Minim Invasive Spine Surg Tech

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“…A Coflex interspinous stabilization, as the third joint offloads the two facets, provides neutral equilibrium of lumbar disorders and minimizes stress concentration in adjacent segments, preventing the occurrence of ASD. Several previous studies have suggested that the Coflex system is safe and effective (Zhao et al, 2018;Shen et al, 2021). Zheng et al (2021) compared the radiographic outcomes of patients after singlelevel Coflex stabilization and traditional posterior fusion for a minimum of 8 years and found no significant difference between the two groups at each time point.…”

Section: Introductionmentioning

confidence: 93%

Biomechanical comparative analysis of effects of dynamic and rigid fusion on lumbar motion with different sagittal parameters: An in vitro study

Wang

Kong

Fang

et al. 2022

Front. Bioeng. Biotechnol.

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Background: Although the management of the lumbar disease is highly dependent on the severity of the patient’s condition, optimal surgical techniques to reduce the risk of adjacent degeneration disease (ADS) remain elusive. Based on in vitro biomechanical tests of the cadaver spine, this study aimed to comparatively analyze the kinematic responses of the spine with dynamic and rigid fixations (i.e., Coflex fixation and posterolateral fusion) after single-or double-level lumbar fusion in daily activities.Methods: Six human lumbar specimens (L1-S1) were selected for this experiment, and the sagittal parameters of each lumbar specimen were measured in the 3D model. The specimens were successively reconstructed into five groups of models: intact model, single-level L4-5 Coflex fixation model, single-level L4-5 Fusion (posterior pedicle screw fixation) model, double-level L4-5 Coflex + L5-S1 Fusion model; and double-level L4-5 Fusion + L5-S1 Fusion model. The pure moment was applied to the specimen model to simulate physiological activities in daily life through a custom-built robot testing device with an optical tracking system.Results: For single-level lumbar fusion, compared to the traditional Fusion fixation, the Coflex dynamic fixation mainly restricted the extension of L4-L5, partially retained the range of motion (ROM) of the L4-L5 segment, and reduced the motion compensation of the upper adjacent segment. For the double-level lumbar fixation, the ROM of adjacent segments in the Coflex + Fusion was significantly decreased compared to the Fusion + Fusion fixation, but there was no significant difference. In addition, PT was the only sagittal parameter of the preoperative lumbar associated with the ROM under extension loading. The Coflex fixation had little effect on the original sagittal alignment of the lumbar spine.Conclusion: The Coflex was an effective lumbar surgical technique with a less altering kinematic motion of the lumbar both at the index segment and adjacent segments. However, when the Coflex was combined with the fusion fixation, this ability to protect adjacent segments remained elusive in slowing the accelerated degradation of adjacent segments.

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“…Lumbar spinal stenosis (LSS) is a degenerative disease of the lumbar spine, common in middle-aged and elderly (1,2). LSS is usually associated with back pain or sciatica, of which neurogenic intermittent claudication is the typical symptom (3,4).…”

Section: Introductionmentioning

confidence: 99%

“…Conservative treatment of SLSS has a great risk of failure, and surgical treatment should be actively adopted. Some studies have pointed out that for SLSS, surgical treatment has a better clinical effect than nonsurgical treatment (1,8).…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy and imaging outcomes of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis

Hao²,

Yang³

et al. 2023

Front. Surg.

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ObjectiveTo investigate the clinical efficacy and imaging outcomes of unilateral biportal endoscopy (UBE) with unilateral laminotomy for bilateral decompression (ULBD) in the treatment of severe lumbar spinal stenosis (SLSS).MethodsWe retrospectively analyzed 50 patients with SLSS treated with UBE-ULBD from October 2018 to March 2021. Visual analog scale (VAS) for back and legs pain, Oswestry disability index (ODI), modified Macnab criteria, complications, hospital stay, preoperative and postoperative dural sac cross-sectional area (DSCA) and Schizas grade, mean angle of facetectomy and osseous lateral recess decompression rate were examined.ResultsThe mean follow-up period was 10.7 months. The mean hospital stay was 2.76 ± 1.02 days. At the final follow-up, VAS for back pain and legs pain decreased from 7.22 ± 0.95 to 1.26 ± 0.44 and from 7.88 ± 0.69 to 1.18 ± 0.39, respectively; ODI decreased from 69.88 ± 6.32% to 14.96 ± 2.75%. According to the modified Macnab criteria, the results were excellent in 24 (48%), good in 22 (44%), and fair in 4 (8%). Excellent or good results (a satisfactory outcome) were obtained in 92% of the patients. There were 2 cases of complications of dural sac tear. The postoperative DSCA was significantly enlarged compared with that before surgery, from 44.74 ± 9.85 to 126.86 ± 14.81 mm2. According to Schizas grade, the stenosis grade changes from preoperative grade C in 16 cases, grade D in 34 cases, to postoperative grade A in 40 cases, and grade B in 10 cases. The mean angle of facetectomy of the ipsilateral facet joint was 70.87 ± 5.68∘, contralateral was 65.07 ± 4.98∘. The decompression rate was 70.81 ± 4.43% (ipsilateral side) and 71.22 ± 3.68% (contralateral).ConclusionsUBE-ULBD has a good clinical effect in the treatment of SLSS, and has achieved satisfactory results in spinal canal enlargement, undercutting of facet joints, and decompression effect. It is a safe and effective surgical for SLSS.

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Comparison Between Fusion and Non-Fusion Surgery for Lumbar Spinal Stenosis: A Meta-analysis

Cited by 16 publications

References 17 publications

Only Surgical Decompression Is Sufficient for Multilevel Lumbar Spinal Stenosis with Calcified Disc Protrusion and Vacuum Disc: Case Reports

Only Surgical Decompression Is Sufficient for Multilevel Lumbar Spinal Stenosis with Calcified Disc Protrusion and Vacuum Disc: Case Reports

Biomechanical comparative analysis of effects of dynamic and rigid fusion on lumbar motion with different sagittal parameters: An in vitro study

Clinical efficacy and imaging outcomes of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis

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